Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby.

Mother and baby need to be together early and often to establish a satisfying relationship and an adequate milk supply.

In the early years the baby has an intense need to be with his mother which is as basic as his need for food.

Human milk is the natural food for babies, uniquely meeting their changing needs.

For the healthy, full-term baby, breast milk is the only food necessary until the baby shows signs of needing solids, about the middle of the first year after birth.

Ideally the breastfeeding relationship will continue until the baby outgrows the need.

Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.

Breastfeeding is enhanced and the nursing couple sustained by the loving support, help, and companionship of the baby’s father. A father’s unique relationship with his baby is an important element in the child’s development from early infancy.

Good nutrition means eating a well-balanced and varied diet of foods in as close to their natural state as possible.

From infancy on, children need loving guidance which reflects acceptance of their capabilities and sensitivity to their feelings.

Do you see anything there are about restricting breastfeeding promotion to women who have declared that they want to breastfeed? Me, neither.

All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances.

It’s hard to be clearer than that.

When called on it, Dr. Flanders began backpedaling furiously. Did he say that “breastfeeding advocacy is not about convincing moms to breastfeed”? What he meant is that HIS personal version of breastfeeding advocacy is not about convincing women to breastfeed.

Would he disavow the statements from leading breastfeeding advocates and their organizations?

Silence.

The Fed Is Best Foundation was created specifically to counter the relentless pressure to breastfeed on women who can’t or don’t wish to do so. I asked Dr. Flanders if he agreed that #FedIsBest.

He responded:

I do not like how the #fedisbest movement has evolved.

When asked to elaborate, he could not or he would not.

Instead, he used a classic obfuscation ploy which he repeated on Facebook where I posted his initial tweet.

Amy, I have said this to you on twitter and will repeat it here (since you thought it appropriate to bring across platforms without mention to me): talking with u is like groundhog day. I know your views on this well. If you haven’t yet figured out mine then you never will. Although I consider it a waste of my time discussing these matters with you, there are a number of interesting folks on this thread with whom I enjoyed dialoguing and I am grateful for the productive discussion.

Yes, Dr. Flanders, I’ve figured out your position. It’s the same passive-aggressive position of many breastfeeding advocates: Pressure women to breastfeed and then, when called on it, deny that you are applying pressure.

Such passive-aggressive behavior has been tolerated for far too long. It’s time to name it, shame it, and force breastfeeding advocates to treat women who can’t or don’t wish to breastfeed with respect.

I now have the dubious honor of being followed by Dr. Jay on Twitter. I had a very predictable convo with someone going by the name Boob Feed this morning. After constantly rebutting her claims, she told me that I sounded “unhinged” and flounced. She hasn’t quite managed to stick the flounce yet. Sheena Byrom also called me unhinged. It’s quite predictable, isn’t it?

Taysha

“Unhinged”?

Are they perhaps confusing you with a door?

moto_librarian

Said person cited a rebuttal to the Concordant Sibling Study by Alison Steube. I pointed out that Steube can’t find any actual data to prove her claims and has resorted to theoretical models, which made her a poor choice for a rebuttal. I was accused of an ad hominem attack.

That’s cool. I hope people are also using that research to further optimize formula.

swbarnes2

But again, cart before the horse. The more you talk up how breastmilk is magic…the more glaring it is that formula fed kids are perfectly fine without any of that. The benefits just can’t be that big, or we’d see them.

Maybe they’ll work out the magic component that reduces NEC, since that effect of breastmilk seems to be robust.

OttawaAlison

Dr Flanders – as a Canadian you are aware that a lot of our health units including Ottawa, Toronto and Peel region have the distinction of being “Baby Friendly” by Breastfeeding Canada (those cover Ontario’s biggest cities). It is endemic. I had my eldest before the baby friendly designation hit in Ottawa, and even then I felt the pressure in spades, ironically enough I was going to be the mom who fed her daughter straight from the so-called tap. The problem is, is that the BFI holds onto an ideal that probably our ancestors didn’t even follow (ebf, no other food or water until 6 months), a cursory study of history shows that women have been trying to get out of this sacred “duty” since the dawn of civilization, using cow, goat milk, mushed up food etc. Women most likely didn’t wait until 6-7 lunar cycles to start feeding their offspring other stuff.

My other issue that gets lost is that many women fall through the cracks through this initiative. It would be so easy to say “women with insulin problems may have problems attaining a full-supply and may need to look at alternative methods to supplement/feed their babies”, but they carry the message that “you will make enough milk” and the message that formula feeding is detrimental can contribute to unnecessary guilt to a new mom. I felt like a horrible human being feeding my daughter formula, but a little bit of the guilt was relieved quickly when my daughter was just a changed little creature within hours. I saw her being satisfied, her tummy was filled, she was a happy camper. She finally produced enough output (something I would encourage every LC/Feeding educator to do is having a diaper with 1 oz of liquid in it to show how heavy they should be – hubby and I are both highly educated and didn’t know how much was supposed to be there. My daughter wasn’t producing enough). Being a mom with a satisfied baby was transforming for all of us. Regardless it took me 2 years to finally get rid of the guilt that was a contributor to a major depressive episode. Nowadays I just want to hug my new mom self and say “she’ll thrive, in the whole spectrum of parenting, this will become a thing of the past that won’t particularly matter in the long run”.

I heard all the messaging “you’re made to do this”, “you will make enough”, “formula is artificial feeding” (when I think of artificial feeding I think of trying to eat wax/plastic fruit), “if you’re determined it will happen”, “if you want the best/to bond you must breastfeed”, “you child will be less intelligent”, “your kid won’t be obese” (funnily enough despite being fed from the tap in the 70s I still struggle with my weight – my primarily formula fed kid however can barely put on weight but I digress), “if you love them than give them the best”. Those phrases don’t bother me anymore because I have had a decade of parenting experience and know that bonding is a continual process, that feeding evolves, that your kid will be who they are. I’ve also had the devastating experience of having a stillbirth and know what bond I had with and still have with my baby girl despite the fact she never took a breath outside of me.

I understand that Public Health is for populations and not for individuals, but the problem is infant feeding is personal. When BFI or Breastfeeding Canada make it seem like an essential part of parenting it’s hard to take yourself out of the big population and say “there are exceptions” and even harder when people basically accuse you of lying about your low supply and accuse you of being lazy and not caring enough about your child (which is a deep insult to any parent). Dr. Amy is actually calling out those who are doing the bullying and for that I am grateful. I don’t want other moms feeling guilt for 2 years. I would much rather see a pragmatic approach to infant feeding be adopted by Public Health units and hospitals. The fact is is that BFI Ontario wants the BFI/BFHI in all public health units and hospitals yet I feel if I were to have another baby (which I would like to have) I would kind of feel abandoned by the units that don’t acknowledge women like me exist. I will be leaving the country for a few years and will choose a non-BFHI hospital, I’m hoping with a pragmatic approach and not a idealistic one.

moto_librarian

Thank you, Alison.

Cody

Have you seen the statement that Florence Leung’s husband made to the media last night? He talks about the BFI and how the pressure to breastfeed contributed to her PPD and suicide. Canadian specific.

OttawaAlison

Sadly yes, I’m glad her husband is speaking out but poor woman and poor family.
There is a systemic issue on how women are treated by these policies and until women are actually listened to when we speak out, nothing will change.

Amy Tuteur, MD

Headline from a piece written by Dr. Flanders: Do We Really Need More Studies Concluding that “Breast Is Best”?

“On the one hand, it is interesting to watch the evolution and growth of the body of literature supporting breastfeeding. It is, after all, very compelling. On the other hand, I must admit that I often feel frustrated watching the accumulation of paper after paper after paper showing the clear benefits of breastfeeding.

Why frustrated? Well, don’t we already know what all these papers are saying over and over again? Quite frankly, no one with a head half-screwed on properly is wondering whether or not breastfeeding is worthwhile…”

Dr. Flanders, you are fooling nobody. The reason you object to #fedisbest is that you have staked your career and reputation on #breastisbest. Without the attention Lactivism has brought you, you would be just another anonymous working pediatrician.

Now the tide is turning. You lactivists finally are being called out for your bullying. You don’t like looking bad, so you’re trying to play it both ways.

Sheven

I have to admit, I doubted this post. I thought that maybe Dr. Flanders really was stating what lactivism should ideally be, or what guidelines the best practitioners of lactivism used. I thought it might not be fair to argue with him about that one statement.

Turns out I was wrong. His article keeps repeating “advocate for” breastfeeding. It has “breast is best” in the title, indicating that it’s a foregone conclusion. It says, “no one with a head half-screwed on properly is wondering whether or not breastfeeding is worthwhile.” But saying “fed is best” is somehow meeeeeen!

Roadstergal

With the clear, nasty implication that women who don’t breastfeed don’t have their heads screwed on right. Their silly, silly woman-heads. Luckily, Flanders is there to set them straight.

Who?

It’s an assertion, not an implication.

Empress of the Iguana People

well, you can argue that about me. he must be awesome with his patients with mental health issues /s

moto_librarian

So Dr. Flanders is not providing evidence-based care to his patients. He doesn’t like Fed Is Best because he is a lactivist. Big surprise.

moto_librarian

Classic confirmation bias.

Cody

I hate to look like a crazy person right now, but you really need to read the article I posted a link to near the top of this comment section. The husband of Florence Leung released a statement to the media last night so this is new and it’s important.

Sheven

This isn’t a response to that exact tweet, but it is about the mentality.

What must really burn lactivists is the spreading awareness that they’ve become the thing they hate. They thought that they were brave, selfless souls fighting against a monetized, uncaring, ignorant, bullying establishment. Now people are pointing out that with the relentless pressure, the professional (and unqualified) classes and seminars, the fact that hospitals are pushing their agenda, the evidence of injured or traumatized mothers and babies, they’ve become the monetized, uncaring, ignorant, bullying establishment. They’re the Empire, not the Resistance.

drflanders

Thanks everyone for the discussion. I must get back to clinic now.

moto_librarian

Way to beat a hasty retreat.

Roadstergal

Stupid Flanders.

Guest

I’ve been waiting for a Simpsons reference!

Roadstergal

I thought myself petty for thinking it initially – then I started reading what he was saying. :p

violinwidow

I wonder if you have breast is best posters hung in this clinic? If so, will you be taking them down since you think claiming fed is best is inflammatory? Does that not also apply to breast is best?

Cartman36

Preach it sister!

Cartman36

Bye Felicia!

Monica

Funny, Dr. Flanders had plenty of time for Twitter last night, but couldn’t come back to answer all these unanswered questions. I couldn’t imagine my kid’s pediatrician having so much time on her hands though. Seriously, that woman is always there. Opening her office on weekends and after hours, calling to check in on my kids after they’ve been seen for a sick visit. If Dr. Flanders isn’t going to do anything about a system that values the actual act of breastfeeding over mothers and babies, then I sure wish he would spend less time on social media sites and more time caring for his patients.

Roadstergal

So, as per Monica below, ‘clinic’ means Tweeting all night? And here I thought lack of respect for women’s bodily autonomy was the only thing you had in common with Trump.

CSN0116

This dude can’t make an affirmative statement to save his life. You’re a pediatrician, Dr. Flanders, not a politician. It’s OK to stand for something and stand for it firmly. No need to play both sides of the fence and placate.

sdsures

I wonder how many weeping, hysterical moms he has had in his appointments, freaked out because they can’t get enough breastmilk to feed their babies? Does he tell them it’s OK to switch to formula then, and not to beat themselves up any more?

Roadstergal

According to the above, he told them that their heads weren’t screwed on right. :

sdsures

*expletive*

sdsures

What does he tell his wife, I wonder?

moto_librarian

Dr. Flanders, you aren’t listening. At all. If you are an evidence-based practitioner, you should be speaking out against the BFHI and the “Breast is Best” campaign. We know that most of the research on breastfeeding is riddled with confounders, socioeconomic status being the most glaring. PROBIT, one of the few well constructed studies, shows an 8% reduction in colds and GI illnesses in the first year. We don’t even know if the latter reduction holds up with uptake of the rotavirus vaccine.

I have yet to see any evidence that supports the BFHI or the common advice meted out by IBCLCs. Where is the proof that skin-to-skin, immediate latching after birth, or pumping every two hours makes a woman’s milk come in faster than simply allowing her to rest and recover from birth? Why do you support an initiative that treats formula like a drug when we know that many women, especially first-time mothers, will experience delayed onset of milk production? Why do cultures that offer formula prior to the onset of milk production manage to have high rates of breastfeeding?

You are speaking out against the wrong organization, and I suspect that you know it. If you can’t admit that, fine, but quit gaslighting us or asking us to check our tone. We don’t need this bullshit, but especially not from a man.

CSN0116

If my husband ever had an opinion of breastfeeding or breastfeeding rates outside of “you do you” I’d be beyond creeped out. I’m trying to to find this guy too off-putting based on gender alone, but…

Empress of the Iguana People

Even my 2nd time around, mine didn’t come in until day 4. That’s a long time for a kid to eat like an anorexic!

fiftyfifty1

At least most people who struggle with anorexia nervosa still manage to take in adequate fluids. The problem with delayed milk and neonates is not just starvation but also dehydration.

CSN0116

What type of physician is this man?

drflanders

For the record, I did express my personal pespective (in Amy’s Facebook page) on #Fedisbest. Curious that she does not mention this in the post above. Here is my point of view for what it is worth to readers of this blog:

From my observation, the #fedisbest movement is grounded in goodwill and a sincere desire to support moms who have suffered from the unfortunate negative outcomes of bf promotion campaigns over the past few decades. I am sympathetic to and supportive of much for which #fedisbest stands. On the other hand, sometimes #fedisbest messages conveyed can come off, at least to me, as inflammatory, competitive, and disparaging (to others who may not 100% align with the #fedisbest mission). The use of the word ‘best’ imparts (or perpetuates – seeing that “breast is best” embraced it first) a spirit of competition which I think we all need to get away from. a hashtag like #fedisbeautiful, #fedisgood, #fedislove, etc. would convey the same meaning without the spirit of competition. But I do acknowledge that #fedisbest is way more clever in that it borrows from the ‘breast is best’ campaign and, in a sense, turns the sights back onto it. Look, I’m in the business of helping and supporting mothers, not trying to compete with folks who have differing ideological views. I get that some folks don’t see it from my specific perspective and that’s OK; we all come from our own places and experiences (and genders – I appreciate that as a man there are parts of infant feeding that I’ll never understand). That notwithstanding, In my opinion we need to get away from the us vs. them, ‘best’ vs. worst, mommy vs. mommy narrative and collaborate (even with folks who don’t necessary see things completely our way), with goodwill, in the spirit of helping moms fulfill their goals.

Sean Jungian

In light of what you’ve written here, I’m surprised you disagree with Dr. Amy at all. Or are “inflammatory, competitive, and disparaging” remarks only intolerable when they are implied to come from the #fedisbest campaign?

Not that I think there should be disparaging remarks toward parents for feeding their infants in whatever way they choose, but it is pretty rich to make those accusations against the #fedisbest campaign while ignoring the years of explicit competition and disparagement brought to bear on formula feeding parents by breastfeeding lactivists.

drflanders

Agreed. Any disparaging remarks are hurtful and undermining to dyads. It breaks my heart to see mothers guilted and shamed for choosing to formula feed (or … choosing not to breastfeed)

Guest

Are you unaware, or ignoring, that fed is best is a response to breast is best? The wording is critical to the message, and is critical to fostering the goodwill you say you value. You are either deliberately making sure women never feel that they are doing the best for their baby unless they breastfeed or you don’t know enough about the current status of breastfeeding rhetoric and demonization of formula feeding to speak about this subject without further education on the state of things.

drflanders

I have acknowledged in my comment above that #fedisbest is a response to breast is best.

Amazed

And yet you somehow missed to acknowledge it on the very public venues where you voice your opposition to “fed is best”.

I’m starting to get a little annoyed with your versatility, Dr Flanders. And more than a little offended. Do you truly think us this stupid? We all know you rely on the people coming in your office every day not to look at Dr Satan’s page. A doctor that you, personally, tried to make look bad, if I may add. We all know you want to make yourself look good to the “fed is best” movement without losing your good stance with your “breast is best” supporters. It isn’t very likely that they’d find this tiny response buried here, is it? While your lengthy anti-fed is best missiles are there for all the world to see.

Guest

So are you deliberate, or acting in ignorance, with your declaration that fed should not be considered best, and that breast should be the only word associated with best?

Amy Tuteur, MD

It seems to me that complaining that #fedisbest is inflammatory is like claiming that #blacklivesmatter is anti-white. It’s deliberately ignoring the context and the stated aims both movements.

drflanders

I vigorously disagree with your analogy.

Amy Tuteur, MD

Which part do you disagree with:

The part where it is a spot-on analogy of opponents deliberately misconstruing aims of an organization they don’t like?

Or the part where it makes you look bad?

Monica

Dr Flanders, I appreciated our discourse on Dr. Amy’s FB page yesterday, but I do think Dr. Amy has a point here about you as well.
There are multiple initiatives which you appear to support and take no issue with how they are presented, but the very thing they are trying to accomplish is exactly the opposite of what you are claiming breastfeeding advocacy is or perhaps should be about. And yet Fed Is Best encompasses everything that you appear to be claiming you believe, but you don’t like it because it appears to be competing with breast is best. I’m still struggling to understand how someone who wants to help and support mothers who have differing ideological views could be against an initiative that is created to do just that simply because it comes off as competing with breast is best.

By speaking out on social media about such topics you are presenting yourself globally to more than just the patients that you see daily. Therefore, it might behoove you to listen to what those women are saying as well. We’re telling you that BFHI and LLL are full of standards that do not support all women and babies and yet they are presented as the gospel of infant care and at least in the case of the BFHI are being forced on women who are disinterested in them. Perhaps you’re in a position to effect changes in these areas if you truly believe the words you have been typing and want to see women being helped and supported. Perhaps you can fill the divide and help get away from the us vs. them mentality by openly supporting Fed is Best and speaking up for all mothers, not just the ones who choose to breastfeed.

drflanders

I would love to fill the divide. I consider it part of my life’s work. I do not affiliate myself with LLL and do have issues with the BFHI. I don’t speak for either of those organizations.

Monica

Do you speak against them like you do Fed Is Best?

drflanders

I routinely object to folks who endorse pushing moms to breastfeed.

Roadstergal

Is that a ‘no’?

Monica

Not folks, I’m asking do you speak out against the philosophies and instructions of the actual programs themselves. You have publicly denounced fed is best as competing against breast is best. I never said you speak for the organizations mentioned, I’m asking you if you publicly denounce them as you have Fed is Best.

drflanders

I do not publicly denounce these organizations but I do publicly denounce SOME of their policies and campaign strategies.

Roadstergal

“I do not publicly denounce these organizations”

Why not? What is there about the BFHI which is _less_ harmful than Fed Is Best?

Monica

Then why do you publicly denounce fed is best? It aligns with what you say here, those other things do not. This sounds an awful lot like paying lip service to me. You’re saying the right words, but when it comes right down to it you really believe all women should breastfeed regardless. That’s what you are saying by denouncing fed is best.

moto_librarian

So why don’t you tell us, specifically, which of those policies and strategies you publicly disavow.

drflanders

I already have. But to summarize – I think a mom should feed her baby how she wishes to feed her baby. Trying to change her mind is not appropriate. I denounce any of the policies that instruct or incent health care providers to attempt changing a mothers mind vis a vis how to feed her baby.

Empress of the Iguana People

The look of disapproval from some of the staff in #2’s NICU could have been damaging to my rather delicate mental equilibrium. Fortunately I had the support of my ob and his partner and my husband. Genuine support. The most arrogant person I met in this whole childbirth experience was a LC. For that matter, the 3rd most arrogant was another LC. (The 2nd most was a naturopath who kept annoying me at the yarn store about whether i was still breastfeeding #1, helps offset those horrible vaccines, you know)

Let’s not summarize. Let’s go step by step on the BFHI. What specifically on there do you denounce publicly? Because it sounds to me like you’re saying you denounce the whole thing, but you’re claiming in reality you denounce SOME of their policies. So you’re going to have to tell me exactly what those are because I must have missed your list along the way. It shouldn’t be hard since you claim to have said it already. So copy and paste would be just fine.

moto_librarian

Then you should be able to name specific aspects of the BFHI that you object to.

Sean Jungian

The Baby-Friendly Hospital Initiative is the very definition of incentivizing health care providers to pressure women into breastfeeding.

Sarah

That’s great to know. But if that’s so, your criticism would be better directed at a dozen places before the Fed Is Best movement.

swbarnes2

You can do better than that, if you wanted to. Do you agree that lactivists push untruths about the stupendous benefits of breastfeeding? My guess is, you will not go on the record as agreeing to this.

drflanders

Likewise I align with many of the values that fed is best stands for. But I do deeply regret how this discussion inflames more than helping to find common ground.

Monica

Then what’s your solution?

drflanders

I never claimed to have the solution to what is obviously a very difficult problem.

moto_librarian

Then why bash it at all?

Monica

But you want to help women. You’re in a position to help women. If fed is best is not that answer then what is?

Amazed

Oh you do have the solution. Bash fedisbest, fall over yourself to glorify breastisbest, claim Dr Amy is anti-breastfeeding, rinse and repeat.

moto_librarian

Seriously, we don’t need to be tone trolled. You should regret the fact that you feel just fine about publicly bashing Fed Is Best while refusing to speak out against Breast Is Best.

drflanders

“I am sympathetic to and supportive of much for which #fedisbest stands.”

The Bofa on the Sofa

Thanks. What part of it are you not supportive of or sympathetic to? I mean, if it’s a legitimate criticism, then I think pointing it out would be helpful.

Amazed

Ah yes, the common ground. Breast is best for all the world to see, fed is best (or at least some aspects are) at Dr Amy’s page where my bestest breastisbest buddies won’t see me betray the ranks, am I right?

Your common ground stinks, Dr Flanders. It smells of dodging and dancing around the issue trying to look good for everyone. Terribly so.

Roadstergal

So, if someone published an article saying that a woman who didn’t want to breastfeed must not have her head screwed on right – you’d strongly denounce that?

Charybdis

Can you please stop with the “peace, light, love, harmony and acceptance to all” crap now? It is insulting our intelligence, not to mention a case of mansplainin’.

And how is “Fed is Best” inflammatory, competitive and disparaging while “Breast is Best” is not?

How can anyone truly be not aligned with the “Fed Is Best” message that actually FEEDING THE BABY is the most important thing? Whether it be exclusive breastmilk, exclusive formula, combo feeding (breastmilk and formula) and whether is is by tube, cup, syringe, bottle, breast, SNS; FEED THE BABY! How can that message be misconstrued? How is it so out of the realm of possibility that people cannot align themselves with their message?

Why not start with the “Breast is Best” crowd with the “change your message” request? Suggest that they adopt #breastisgood, #breastisbeautiful, #breastislove, since they are the ones who started it?

So, in the spirit of goodwill and helping moms fulfill their goals, what would you say to someone who has no intention to breastfeed; that their baby is going to be exclusively formula fed?

drflanders

If you mean in the context of a well baby visit to my clinic, I would say ok and offer to discuss whatever she has on her mind for the encounter.

mythsayer

How come you didn’t address any of the other points Charybdis made? It’s this type of dodging that makes you look disingenuous. If you won’t actively denounce the “breast is best” campaign, we aren’t going to to do it for you. Do you see the problem here? You seem to have zero issues with explaining your objections to “fed is best” but for whatever reason you won’t address problems with “breast is best”. Oh sure, you mentioned it once, very quickly, in another post. You didn’t actually delve into much, though.

drflanders

Not intending to dodge. I do take great issue with many aspects of the breast is best campaign and feel awful for the many dyads that have suffered as a consequence.

Amazed

I’m so glad to hear it, Dr Flanders. I believe you as I do my own Bible.

Oh wait, I’m an atheist. I don’t believe my Bible. I don’t own one. And I don’t believe you. Not after what I’ve seen of you this far – and that’s ALL I’ve seen of you.

Would you please show me any posts of yours showing your great issues with many aspects of the breast is best campaign? I mean, posts that are given equal prominence to your “no, no, fed is best isn’t best” stance? I noticed that you tactfully refrained from voicing your great issues when asked at Dr Amy’s page.

Sarah

That’s good. Have you written about this and if not, do you intend to?

The Bofa on the Sofa

You know, that would have been a great response to the comments the other day on Twitter and Facebook.

It evolved from healthy, term infants who suffered severe disabilities or died because their mothers’ concerns about insufficient breast milk production were ignored until the child suffered brain damage.

It evolved from women who spent their postpartum days with their newborn struggling to produce breast milk and going through absurdly time-consuming pump-feed-supplement schedules that have very little grounding in how milk production works in mammals.

It evolved from women like me. I was told by a LC on the day of an emergency CS at 26 weeks gestation due to Class 1 HELLP syndrome that it was absolutely critical that my premature son receive breast milk and that I had to pump every 2 hours around the clock for the next two weeks for my milk supply to come in.

Did it matter that my BP was still in the 180’s/100 range and not responding to first-line drugs?

Did it matter that I was so severely anemic that I couldn’t pump both breasts at once because I didn’t have the physical strength to hold two pump attachments for 20 minutes against my breasts? Or that when I walked the three steps to the bathroom with people supporting me I needed to catch my breath sitting on the toilet?

Did it matter that donor milk was available?

Did it matter that I had already produced several mL of colostrum in my initial pumping attempts that we had brought down to the NICU?

Did it matter that most of the FTM who give birth to severely premature infants will never end up producing more than a fraction of the milk needed to feed their infants?

Did it matter that spending 3-4 hours a day attached to a pump is damn near impossible when you have to work, care for other children or travel any distance to get to the hospital?

In case you are wondering, NOTHING mattered except me sticking to a lunatic schedule. She’s also one of the two LC consultants who works specifically with NICU moms. Considering that gives her a client load of between 40-50 women, you’d think she’d have learned the obvious.

It’s been seven weeks. She’s never asked how I’m doing physically or emotionally – just if I’m producing enough milk.

It’s been seven weeks. She’s never learned my son’s name or asked how he is doing.

I’m really sorry that you suffered that experience. I agree that your treatment by the healthcare system was unacceptable. I do not and will not hesitate to speak out against poor care and support for dyads. Poor care is poor care no matter where you stand on this discussion.

Roadstergal

But do you speak out against this type of care as vigorously and loudly as you speak out against Fed Is Best?

How can you not see that the whole point of Fed Is Best is taking the teeth out of the toxic Breast Is Best?

My LC isn’t a rogue operator; she’s following the standard advice given to new moms including NICU moms.

She is also completely unaware of the fact that the 2-hour round-the-clock pumping advice is not evidence-based or supported by any sort of research. Or that treating sore nipples with breast milk doesn’t work that well. Or – in my favorite moment – arguing about the size of my nipples when I’m fully dressed and she’s never seen them is really counter-productive from a treatment point of view but makes an amazing anecdote at family gatherings.

In all honesty, I see her as a victim in this whole theme as well. She’s dedicating her life to a series of instructions that are self-defeating and will cause many moms to quit breastfeeding or pumping. That’s a shitty way to live and she’s showing the strain already.

Who?

Mel, that’s her choice. She could choose to learn more and do better. She could choose to follow up and see how people go long term. She could even line up a binch of toddlers and realise she can’t identify the breastfed ones.

She’s part of the problem.

Lovely to hear all about Spawn-glad he’s doing well.

moto_librarian

A lot of us have suffered these experiences. And if you aren’t actively speaking out against the BFHI, you aren’t helping us.

Amazed

And yet you only speak against “fed is best”.

I’ve seen you here before, Dr Flanders. I followed your input on Dr Amy’s page yesterday. Let’s say that your behavior was – still is, as far as the reply you gave Mel is concerned – just on par with my expectations of you. You talk the talk but you never miss the chance to subtly or not so subtly disparage “fed is best”. You deny to be affiliated with LLL and the likes but I’ve never seen you ever give them the slightest bit of disapproval. Your speaking against practices like the LC Mel described looks like an attempt to make yourself look the good, responsible physician. In your quest to do this, you deliberately misrepresent Dr Amy’s position. I don’t believe you treat the women coming to your practice with the respect you lay claim to at Dr Amy’s Facebook page.

Prove me wrong, Dr Flanders. Or if I am not wrong, answer this: Do you believe that the benefits of breastfeeding are trivial? If they are, why are you against “fed is best”? If they aren’t, why do you claim respect to a mother’s choice that you feel endanger her baby?

drflanders

The benefits and/or risks to a dyad of breastfeeding is trivial to some and not trivial to others.

I am not against fed is best. In my comment above, In addition to criticism I have expressed fondness and sympathy for fedisbest

If a mom’s baby is in danger, I respectfully intervene

Roadstergal

“The benefits and/or risks to a dyad of breastfeeding is trivial to some and not trivial to others”

Are you in a competition for content-free statements?

fiftyfifty1

“The benefits and/or risks to a dyad of breastfeeding is trivial to some and not trivial to others.”

Oh dear, that’s terribly vague. I’ll fix it for you:

To tiny preemies and to babies in locations where commercial formula and clean water are not reliably available, the benefits are not trivial. To everyone else, the benefits are trivial

Amazed

Ah, I see. More gaslighting. Let’s use the preemies and babies in places where the status of water in uncertain as an excuse to stay silent against practices that upset, humiliate, and put fear in women from first-world countries where the differences are literally 8 percent gastro issues less in the first year of life. By the way, is this 8% even existing now, after the rotavirus vaccine came around?

BeatriceC

The problem is that Mel’s experience is closer to the norm than a outlying bad experience. And it’s also not a very new thing. I had a remarkably similar experience as the mother of an extremely premature baby 14.5 years ago in a hospital thousands of miles away from where she lives. The difference between me and Mel is that when I had my micropreemie I wasn’t a first time mom. I wasn’t even a first time NICU mom. That was my third time through NICU hell, and I had an idea of what I would encounter. I also knew my own body fairly well, so I completely ignored the LC’s who tried to get me to pump around the clock and focused on sleep and my own physical recovery instead. And guess what? Just like with all my other babies, my milk came roaring in midway through day 3 with or without pumping, and I was as well rested and recovered as possible, making pumping actually beneficial.

Unfortunately, Mel didn’t have the advantage of having multiple other kids to have an idea of how her body was going to work. Fortunately she’s a regular reader of this blog and other evidencebasad sources and knew enough to not fall for the non evidence based and probably harmful advice she was given. Too many other mothers don’t have even that advantage.

So unless and until you acknowledge that the type of harmful behavior is the norm, and call out the BFHI, LLL and “Breast is Best” in public, and apologize to “Fed is Best” for attempting to sabotage them with half truths and outright lies, then trying to gaslight people when you’re called on it, your words are as meaningless as the apology that’s inevitable from the abusive man who’s just beat up his wife.

Whenever I would be trying to decide if I should pump or sleep, Nico would pipe up with “Mel, if we had a cow who had severe side-effects from milk fever and decided that we should start miking her right away to “protect her supply” rather than letting her rest for a day or so, you would….”

Mel “Call Animal Control. Got it. Going to sleep.”

BeatriceC

I almost said something about being a dairy farmer, but I was unsure of how accurate my comparison would be, so I left it out.

Empliau

Everyone needs a Nico. Can he be cloned?

swbarnes2

Come on. Be honest. It wasn’t the “healthcare system”. It was the LCs. It was the “breast is best” ideology of the LCs. The ideology that you can’t quite bring yourself to criticize plainly.

Jennifer

Maybe not quite on topic, but I find it creepy as heck to describe a woman and her baby as a “dyad”. It seems to be a way of still regarding a woman as pregnant and of putting all the responsibility for the newborn’s care on her. The father has a role as well. More importantly, the maternity ward staff has an important role in taking care of BOTH patients, just as any other patient in a hospital would be taken care of.

Think of it this way: if the mother were the only member of the family who was a patient of that hospital, how would she be treated? If the baby were the only member of the family who was a patient of that hospital, how would he/she be treated? Why is so the standard of care so much lower if they’re both in the same hospital?

Referring to two separate human beings as a “dyad” is dehumanizing to them both. It’s even more disturbing than hospital staff who all refer to a new mother as “Mom” or “Mama”. Staff in every other department manage to call patients by their actual names, maternity staff should as well.

Sean Jungian

I found it off-putting as well. I understand why he used that technical term, but I personally try to say “parents” rather than just “mother”.

I really hate how NCB has tried to completely erase not only fathers, but extended family from the family equation. You need a support system, whomever that may include.

momofone

So true. And crazy as it may sound to some people, there are actually fathers who want to be involved in caring for their babies from the beginning. My husband would never have gone for being relegated to the third year of our son’s life.

Sean Jungian

A lot of today’s fathers are trying to be more involved. Then you get jackasses like this guy and NCBers completely erasing them from the family and childcare.

Toxic masculinity hurts men and boys, too.

My son has always LOVED babies and looks forward to having a family. I’ve no doubt he will be very involved in his childrens’ lives in the future. But he hesitates to even SAY anything like that to anyone but me, due to the pressures still brought to bear on men and boys to be “manly”. When you position mothers as the ONLY source of parental care an love, you just reinforce this bullshit paradigm.

KeeperOfTheBooks

YES!
With DD, I was so far into the woo that I was sure I was the only person who could properly care for her, which meant she wasn’t happy with Daddy until she was about 18 months or so.
I think it was about 3 days after I got home from the hospital with DS that I asked DH to take him for a couple of hours while I got a nap one night. So, he and DS kicked back and watched Planet Earth while I got a much-needed snooze. They eventually got a sort of tradition going where a few nights a week they’d crack open a cold one (beer for DH, bottle for DS), snuggle on the couch and watch/discuss the local baseball game while I rested. As a result, while no one else will every be “mum-ma!”, DS is very comfortable with DH and loves hanging out with him, and I didn’t feel like I had to go it all alone. Win-win, sez I!

I couldn’t quite figure out what I felt was so off putting about his phrasing. I think you nailed it. If my baby and I are a dyad, we’re not people, and don’t have to be treated as such.

EmbraceYourInnerCrone

I felt the exact same way about that word. A parent and their infant are NOT one entity. That’s just creepy. Well, that and for some reason it bugs the crap out of me when people CONSTANTLY refer to just the mother and the baby.
It’s like anything that is not a traditional nuclear family does not exist. Foster kids exist, adopted kids exist, daddies exist, gay and lesbian parents exist. And if all these idiots think the only parent that TRULY bonds with the child is the one that breastfeeds the child, they need a smack upside the head.

moto_librarian

Yes! Thank you for pointing out the inherent sexism of the mother-baby dyad.

Roadstergal

You know, I think it’s very much on-topic. It’s all part and parcel of “a woman isn’t a unique individual with her own wants and needs and preferences, she’s an extended placenta who exists only to stay physically attached to and nourish her child.”

I love hearing about Spawn! Our regional neonatal intensive are unit holds reunions for all their ‘graduates’. It’s amazing to see all the toddlers and children running about like mad things-one of my neonatal colleagues posts before and after pictures (with parental consent of course!), and the change from the scrawny skinned rabbit look with masses of tubes and lines in to happy mobile munchkins is just lovely to see. It gives the staff such a buzz to see how well their kids do even after the stormiest of starts. I hope Spawn graduates soon!

Montserrat Blanco

I am really glad to hear that Spawn is doing well. And I say +1 to your comment. I do not feel like commenting a lot today but the best LC vignette was: I was not producing enough milk, so I found the “best” LC in my city, asked for an appointment by email because the phone hours were not working for me with my usual NICU times. I said I was the mom of a preemie and he was still at the NICU. Got answered to bring my baby to the appointment. Answered back that I would bring my pump. She did not apologize. When I failed to answer in less than four hours about the appointment time that was right for me she gave both available appointments to other moms and did not offer any other time of day. I got the message that I was obviously not a priority and that I should look somewhere else. It was the worst bedside manners I have ever experienced.

KeeperOfTheBooks

I don’t comment as often as I used to, but I do want you to know that I’m praying for you and Spawn, and that I stop in here as much as to check on the latest Spawn update as for anything else. Know that we’re all here and routing for you! As for me, I still remember your very, very kind post when I wrote here about my PPD, and I hope that the real life people around you are taking most excellent care of you, that wretched bitch aside. I still look back on what you wrote to me on bad days, and it helps. It helps.
I am so sorry about that LC, and hope that, once time permits, you write a scathing letter to hospital administration about your experience. Absolutely, positively NO ONE should be treated like that.

Empress of the Iguana People

It isn’t “formula is best,” Doc, it’s _FED_ is best. The alternative is going hungry. So when my 57 year old friend’s mom fed her condensed (cow’s) milk as a baby, it wasn’t optimal but better than letting C starve. I bf’d #1 but it’s a trigger for my suicidal depression this time around, so #2 is eff. If I hurt her or myself because “Breast is Best” then clearly it isn’t. Competition?! Because “Breast is Best” or “Breast is Love” isn’t competitive. What planet do you live on?

And then there’s my sister who started chemo 3 weeks after nephew was born because her previously unsuspected cancer had spread to his umbilical cord. How do you think she felt every time she took her kid in for his well-checks only to see breast is best scattered all over? Every blithering idiot aquaintance asking if she knows to bf because it’s best, never mind that her milk was poisonous?

The competition is with people who push bf to the point where children are actually starving because their moms just don’t make enough for them. Maybe only a few, but it’s still far too many where we have a perfectly legitimate alternative.

moto_librarian

So do you support the end of the “breast is best” campaign given that it is based on flawed research that vastly overstates the benefits of breastfeeding a term infant in the developed world?

Roadstergal

Not to mention that it downplays the immediate risks to mom and baby, and potential long-term risks of food allergy and early-starvation-induced developmental issues?

Erin

I think it’s interesting that you make the leap to one of competition. I see it as more a statement of fact. Getting nutrition into your child is best. If breastfeeding works for you and your child, awesome. If not, here is an alternative method of feeding your baby.

I could have fed the whole of NICU with my milk but I can not describe how triggering, how repulsive and revolting I found breastfeeding. At every step health care providers told me to keep at it, told me “I shouldn’t have got pregnant if I wasn’t over being raped” (helpful when you’re holding the baby) and told me how much I’d fail him if I gave him formula. A health visitor even suggested making some up and drinking it myself so I could see how awful it smelt and tasted.

Masochist that I am, I’m planning on having another shot with baby 2 (scheduled to make an appearance soon) and I hope it goes better this time but if it doesn’t I won’t hesitate to change feeding method.

Empress of the Iguana People

Good luck!

Erin

Ta. Starting to get nervous.

moto_librarian

I sincerely hope that your choices will be respected, and that you will wake up from a lovely nap with a clean, bundled babe to enjoy.

I really don’t know how anyone can have that as a take-away. Women are BOMBARDED with “Breast is best.” It’s on the walls of pediatrician’s offices, on the walls of pumping rooms, on the gorram bottles of formula!

How is _that_ not competitive enough to be worth your public time speaking out against, but a sensible, healthy push-back of ‘Fed Is Best’ is?

fishcake

“Fed is Best” is inclusive of all methods of feeding a baby. “Breast is Best” is not.

Sarah

You mention perpetuating a spirit of competition, which I think indicates that you’re aware lactivism ‘started’ this.So that part is encouraging. However, have you applied the same criticism to lactivist organisations as you do to Fed Is Best?

fiftyfifty1

Do you seriously think that #fedisgood is a good rejoinder to #breastisbest? Wow. This says a lot about how your viewpoint is still strongly invested in creating and maintaining a hierarchy.

maidmarian555

I’m just wondering Dr Flanders when the last time you had your breasts physically manhandled after labouring for the best part of four days? Because Breast is allegedly Best? When did a bunch of women you didn’t know physically grab you and pull away your clothes and take your sleeping, infant son from his bassinet because they “needed to see you feed from the other side”? (Not 20 minutes after they’d subjected you to the same humiliating ritual on one breast already?) When did they pull down your top and expose you on a busy ward so everyone could see your naked body? Because Breast is Best. No matter the cost to the mother, of course…. It’s really not about ‘mommy wars’ or any of that crap. It’s about women, mothers, mummies, moms. Who just want to be treated like humans and not like cattle. We don’t want to be humiliated for the sake of ideology (which is what the women who humiliated me hid behind). At the time, what mattered was that my son was fed. It wasn’t OK for other women to abuse my body for that.

#fedisbest supports women like me. I wanted to breastfeed my son. I did, for some months. If it had been down to the breastfeeding advocates in the hospital in which I gave birth, I’d have stopped immediately. I don’t know a single woman who doesn’t align with the #fedisbest movement. Because it actually supports us all. It helps us all meet our goals with zero judgement. I can’t say the same about lactivists. Sorry.

moto_librarian

Every single lactivist always pulls the “well, it’s not the BFHI but how hospitals and staff are implementing it” canard whenever we share our stories about being treated badly. It’s pretty clear that there are women from all over the U.S., Canada, and the UK who have all been treated like shit and given bad information. It’s pretty clear that it IS the policy.

Monica

If there’s room for ambiguity in the policy, which I’d say there is, then it’s the policy itself not how it’s implemented. The entire thing ignores the women who do not have a desire to breastfeed or room in with their babies right after delivery anyways. I was all for keeping my babies with me as much as possible in the room, but since my husband couldn’t stay in the room all night long due to other children or job responsibilities, getting breaks so I could sleep before going home was crucial to my recovery every single time. There are no caveats in those ten steps which say anything about what to do for mothers who need a break.

It’s like the pendulum has swung too far in the wrong direction. Once upon a time rooming in wasn’t allowed at all for any woman. Women didn’t like that so they changed the policy so if you wanted your baby in the room you could have your baby in your room. Now they’re going towards all women must have baby in room regardless of desire.

Seems to me, if you want to blame the hospitals for misinterpreting the guidelines, then the easiest way to fix that is to make the guidelines less ambiguous. But you know that’s just me going and being logical and making sense. Changing the policy though means less chance of forcing all mothers to breastfeed and room in with their child.

Roadstergal

IMO, the ambiguity is a feature, not a bug. If they set out what they really wanted in the policy in black and white, it would be more clear how unreasonable and abusive it is, but with it as it is, they can weasel out of any complaints about the implementation.

maidmarian555

One of the midwives who humiliated me was the top breastfeeding specialist in that hospital. She runs their breastfeeding clinic. She’s one of the people training new midwives there (it’s a University hospital so that’s where they go to learn their craft and get qualified) on how to ‘support’ breastfeeding mothers. It’s a deeply systemic problem where this stuff has clearly been allowed to go on unchallenged for years and years. You are absolutely correct when you point out that this is happening all over the place. The ideology is deeply entrenched, it’s not just ‘rogue’ individuals.

moto_librarian

I sometimes wonder how many LCs have trained with LC Ratchett at my university medical center. She is the only healthcare provider that has ever touched me without consent.

maidmarian555

I think that’s why it left me feeling so traumatised. I’ve *never* had anybody in a medical setting touch me without consent. Let alone when I was actively saying “No”. It was such a shock. And seems to be something very much connected with breastfeeding specifically. Why do they think it’s ok? I really don’t understand why all the normal ‘rules’ go out the window at that point.

Petticoat Philosopher

I really don’t see how “fed is best” in any way fosters a spirit of competition among mothers. Like you say, it is a riff of “breast is best,” that is explicitly meant to express the message that there is more than one right way to feed a baby and nobody is a better mother for choosing one method over another. It is not contrasting one method of feeding with another. It is contrasting feeding a baby with not feeding a baby–due to a dogmatic devotion to breastfeeding, even when it isn’t working. If that is “competition,” well, I guess I’m fine with that. I abhor competitive mothering when it is about championing one parenting choice over other equally acceptable parenting choices, thus shaming those who make those other choices. And that is what it usually is. But not feeding a baby, because the method of feeding is seen as more important than whether or not the baby actually gets enough nutrition to live and be healthy–that is not an acceptable choice. I have no problem with shaming it. If you can’t openly condemn the choice to risk starving a baby–a risk which it seems many alternative health advocates and even hospitals are willing to take now–what can you condemn?

fiftyfifty1

Classic gaslighting.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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